A young woman has died of cervical cancer after being refused a smear test at
the age of 24. Radhika Sanghani, the same age, asks whether the
national age limit should be lowered

When I tell that to women in their thirties and beyond, most are shocked. They had their first cervical cancer screening (AKA smear test) when they were 20 years old. They’ve been having them regularly ever since and can't see how I, a 24-year-old woman, could be any different.

But, ever since a review in 2003,you now have to be 25 to have a smear test in the UK (it's still 20 in Scotland but that's due to change next year, too). It means that I have to wait another eight months before the routine screening invitation drops into my letterbox and I can put my mind at rest.

It might sound strange to be so keen to have a smear - I’ve heard they’re pretty uncomfortable. But I’ve been waiting desperately for this ever since I was 18 and befriended an American girl. She was 20 at the time and had already had two smear tests. She had a ‘gyno’ and knew seemingly infinite amounts about her vaginal health.

I didn’t. All I knew were the sketchy basics we’d learnt in Biology class, and bits of info about thrush that I’d gleaned from TV ads.

But, at the age of 16, my friend had her first smear. Though she was declared cancer-free, the doctors found a cyst. It turned out to be dangerous and removing it, she told me, "like, totally saved my life".

Of course, the minute I discovered this, paranoia set in and I became convinced I had numerous cysts, not to mention cancer, lurking in my pants.

Woman denied smear test dies

I’ve since calmed down – numerous Googling sessions of cervical cancer causes have helped. But I was shocked, today, to read the tragic story of26-year-old Dawn Weston who died of cervical cancer. Because Dawn was 24 (my age) when she visited her GP with back pain and asked for a smear test. She was denied the procedure because she was under the age 25.

Dan and Dawn Weston

After repeated visits to the GP - and turning 25 - she was given the test, which confirmed she had cancer. But it was too late and she died earlier this year. Her husband, Dan, is now campaigning to have the screening age lowered back to 20.

It seems like a great idea. Young women like me would be able to check their reproductive health as soon as they left their teenage years, instead of waiting until their mid-twenties. It could save countless lives and, more than that, put young minds at ease.

Except, according to those in the know, it might not. Robert Music, the chief executive of charityJo’s Cervical Cancer Trust, tells me: “We, like other charities, have to be guided by the current evidence and what the experts say, which is that it can do more harm than good [to lower the age]. But what’s important in under 25s is to be aware of symptoms.”

Smear tests might cause more harm than good

So what's the issue? Cervical cancer screenings look for early abnormalities, which could develop into cancer. They can then pick up on the HPV virus which typically causes the disease. But this is a common virus in young women anyway and, most of the time, it goes away on its own.

Doctors worry that if a young woman is told she has HPV aged 20, she’ll be anxious until her next test three years later - at which point they would expect it to have gone away without treatment. If HPV is discovered too early, there's a risk of over-treating, which can lead to fertility problems later in life. And it is still rare for younger women to have cervical cancer - with an average of just 2.6 cases per 100,000 women, according to Public Health England. It's for these reasons that the age limit was moved from 20 to 25 in the first place.

The evidence makes sense on paper. But, the problem with these guidelines is that they’re just that – guides. They don't take into account the anomalies like Dawn and it's dangerous for GPs to take them as the gospel truth.

Dawn should have been given a diagnostic test (what doctors use for people who already show symptoms) as soon as she mentioned her pain, but it looks like her GP didn't suggest this immediately. Public Health England has recently tweeted that women with symptoms, and aged below 25, are eligible for testing. But the risk is that not all GPs will go through with this.

A grey area

Equipment used for smear tests

Consultant gynaecologist Hugh Byrne tells me that “it’s a grey area” and “the guidelines are often misinterpreted.” He explains that sometimes patients have to press their GPs to refer them for a smear test. But there's one aspect it's definitely not 'grey' with, and that's the age.

Even if you have been sexually active for a number of years, you cannot have a smear test on the NHS. A GP may allow it, but the lab it goes to have the right to not analyse your results unless you are 25.

I had no idea this was the case - and a quick poll of friends and colleagues shows I’m not alone. If we’re being really honest, this isn’t the only aspect of our vaginal health that we have no idea about. We know we should get checked for sexually transmitted infections, because that was drilled into us at uni. But what about general infections? Or those cysts my American friend mentioned? Should we have gynaecologists of our own – can you even get them on the NHS?

Byrne explains that in some countries like America, women have smear tests at six month intervals from an earlier age, because doctors are paid more for carrying out the tests. “It’s in the doctor’s interests to bring them back repeatedly for tests they don’t need,” he explains. “The NHS programme is designed to be cost effective and you rarely find tumours.”

Be on top of your own health

He adds that you don’t need to have regular gyno check-ups, and should only see one if you have symptoms you’re worried about. That's all very well, in theory. But what if you have symptoms that your normal doctor doesn't seem concerned about? How do you know?

I've experienced this confusion myself. I thought I might have a vaginal infection, but I wasn't sure. And I certainly didn't know what it could be. The GP I spoke to said it was probably thrush, but that maybe it could also be something else. She then said, as neither was serious, why didn’t I "just try a couple of these creams?"

I took them from her in confusion and ended up not using either because I was scared I'd invented the symptoms and didn't need the creams after all. I was worried that it could make it worse if I used the wrong one. But when I tried to ask her about this, she told me her next patient was waiting.

At no point was I offered an examination, or referred to a gynaecologist. Byrne admits that’s a problem you do find with GPs. If you have a vague idea of what your symptoms could be and it’s nothing too serious, they’ll just diagnose you and offer medication. They won't bother with an examination because they're just too busy.

It’s a far cry from the American system where your gyno would probably pick up on the infection before you even knew it existed. That said, we're lucky to have the NHS. The solution? To keep visiting the GP if we're worried and do our best to know what's going on with our own bodies.

I understand the reasons why women are only allowed smear tests from 25 onwards, but I do think there should be more flexibility. If someone is really anxious, then why not let them have a test early? It could really assuage their worries and, if they did have something like HPV but it looked harmless, a simple explanation could put them at ease. As Byrne says: "It wouldn't be such a huge number that the Government would be bankrupted."

But, as it doesn't look like this is happening any time soon. So, in the meantime we need to police our own bodies. We need to be aware of the symptoms for cervical cancer (there’sa useful guide here), and it wouldn’t hurt if we knew about general vaginal infections either. Our GPs are the only ones who can help us with serious health issues, but it looks like it's up to us to press them on those blurry guidelines and make sure our vaginas are taken seriously.